结直肠癌组织中Twist蛋白的表达及意义

Expression and significance of Twist protein in colorectal cancer

目的 探讨结直肠癌组织中Twist蛋白的表达及其与结直肠癌患者临床病理因素和预后的关系.方法 回顾性分析2005年6-9月南方医科大学附属顺德第一人民医院收治的45例结直肠癌患者的临床病理资料.收集患者行手术切除的结直肠组织标本进行研究.采用免疫组织化学染色检测45例结直肠癌患者癌组织及癌旁组织中Twist蛋白的表达情况,分析其与结直肠癌患者临床病理因素及预后之间的关系.采用门诊和电话方式进行随访,随访时间截至2013年9月.计数资料比较采用χ2检验或Fisher确切概率法.采用Kaplan-Meier法绘制生存曲线,采用Log-rank检验进行生存分析.预后因素分析采用COX单因素和多因素分析.结果 Twist蛋白的表达主要位于细胞质.结直肠癌组织及癌旁组织中Twist蛋白的阳性表达率分别为62.2％ （28/45）和20.0％ （9/45）,两者比较,差异有统计学意义（χ2=18.383,P＜0.05）.TNM分期为Ⅰ∽Ⅱ期结直肠癌患者Twist蛋白阳性表达率为42.1％,Ⅲ∽Ⅳ期患者为76.9％.N0期结直肠癌患者Twist蛋白阳性表达率为41.7％,N1∽2期为85.7％.不同TNM分期和淋巴结转移的患者结直肠癌组织中Twist蛋白的表达比较,差异均有统计学意义（χ2=5.662,9.244,P＜0.05）.45例患者均获得术后随访,随访时间为10∽96个月,中位随访时间为54个月.Twist蛋白表达阳性和阴性的结直肠癌患者中位生存时间分别为44个月和69个月,5年累积生存率分别为10.7％和82.4％,两者生存情况比较,差异有统计学意义（χ2=26.147,P＜0.05）.单因素分析结果显示：Twist蛋白表达是影响结直肠癌患者预后的相关因素（HR=8.669,95％可信区间：2.959∽25.390,P＜0.05）.多因素分析结果显示：Twist蛋白表达阳性是影响结直肠癌患者预后的独立危险因素（HR=5.059,95％可信区间：2.888∽8.863,P＜0.05）.结论 Twist蛋白在结直肠癌组织中表达升高,这与结直肠癌的发生、发展密切相关.Tiwst蛋白表达阳性是影响结直肠癌患者预后的独立危险因素.

Objective To explore the expression of Twist protein in the colorectal cancer （CRC） and its relationship between clinicopathological factors and prognosis of patients.Methods The clinical data of 45 patients with colorectal cancer who were admitted to the First People＇s Hospital of Shunde from June 2005 to September 2005 were retrospectively analyzed.The colorectal tissue specimens from surgical resection were collected.The expressions of Twist protein in the cancer and paracarcinoma tissues were examined by the immunohistochemistry,and their relationship with clinicopathological factors and prognosis of patients was analyzed.Patients were followed up by outpatient examination and telephone interview until September 2013.The count data were analyzed using the chi-square test and Fisher exact probability.The survival curve was generated using the Kaplan-Meier method,and the survival analysis was conducted using the Log-rank test.The prognosis factors were analyzed by the COX univariate analysis and multivariate analysis.Results The expression of Twist protein in CRC was predominantly detected in the cytoplasm of the tumor cells.The positive expression rates of Twist protein in the CRC and paracarcinoma tissues were 62.2% （28/45） and 20.0% （9/45）,respectively,with a significant difference （χ2 =18.383,P 〈0.05）.The positive expression rates of Twist protein were 42.1% in patients with Ⅰ-Ⅱ stage of CRC and 76.9% in patients with Ⅲ-Ⅳ stage of CRC.The positive expression rates of Twist protein were 41.7%in patients with N0 stage of CRC and 85.7% in patients with N1-N2 stage of CRC.The expression of Twist protein in patients with CRC was however associated with the TNM stage and lymph node metastasis （χ2=5.662,9.244,P 〈 0.05）.A total of 45 patients were followed up for 10-96 months （median,54 months）.The median survival time and 5-year cumulative survival rate in 45 patients with positive expression of Twist protein were 44 months and 10.7%,which were compared with 69 months and 82.4% in 45 patients with negative expression of Twist protein,with a statical significance in the survival （χ2 =26.147,P 〈 0.05）.The results of univariate analysis showed that the expression of Twist protein was an related factor affecting the prognosis of patients [HR =8.669,95% confidence interval （CI）：2.959-25.390,P 〈0.05].The results of multivariate analysis showed that the positive expression of Twist protein was an independent risk factor affecting the prognosis of patients （HR =5.059,95 % CI：2.888-8.863,P 〈 0.05）.Conclusiors The increasing expression of Twist protein in the CRC is positively correlated with the occurrence and development of CRC.The positive expression of Twist protein is an independent risk factor affecting the prognosis of patients with CRC.